About IFEHC - Overview

IFEHC proudly delivers superior healthcare. All cases are seen by the Medical Director. Except for referrals (at the consent of the patient), all cases are seen directly by the Medical Director. Visits are by appointment only. This ensures each patient is given adequate attention. Because there is no waiting room contact with other patients, there is minimal of acquiring the pandemic or any other infection.  According to a 2016 Johns Hopkins study, healthcare setting-acquired infection is the #3 cause of death in the U.S.  This is a solo practice. There is no hand-off between providers. Hand-off is a known source of medical errors due to miscommunications. Moreover, IFEHC seeks input from the community. It is in the process of seeking input from the area it serves on what is important to them.

Quality control is attained by providing and measuring patient-centered care, team-based comprehensive coordinated care, a systems-based approach to quality and safety, and enhanced patient access.

IFEHC takes the security of your medical data very seriously. First, you will not sit in a waiting room. Other people patients will not learn, even incidentally, that you are a patient. Second; because IFEHC does not collect insurance information, there is NO explanation of benefits sent to the main policy holder. Third, IFEHC does not collect information it does not consider pertinent to giving quality medical care. Fourth, IFECH does NOT sell your information to third parties. It only discloses with your consent or when legally mandated. Fifth, IFEHC is among the few medical establishments that still uses paper charts where permitted by statute(s). This minimizes risks of cyber attacks. Please see applicable disclaimer(s). Sixth, IFEHC is the only medical establish of which we are aware that routinely sends via USPS Certified Mail sensitive communications. This is very costly, but it guarantees that only the intended individuals receive sensitive communications.

Please be advised that an important exception to this principle is committing crimes on premises. If the Medical Director or anyone else HIPAA authorized has good faith reason to believe services (including treatments) were obtained by fraud, IFEHC reserves the right to notify appropriate regulators and/or law enforcement and to cooperate fully. In IFEHC's legal interpretation, the commission of fraud or any other serious crime invalidates any agreements made with IFEHC.

Revised August 6, 2024

We have always taken pride in using paper records to ensure patient and examinee privacy. IFEHC draws to the public's attention that certain states' statutes require a transition to electronic health records. As of the date of this publication (08/06/2024), we are no longer guaranteeing that we can honor any patient's/examinee's preferences not to use electronic health records. When we ask patients/examinees to indicate preferences, answers should be understood exactly as that: preferences. We will do our best to honor them. If applicable statutes conflict with what patients/examinees request or the requests otherwise present undue burden(s) to business, we may not be able to honor them. If we we agree to provide service and cannot honor your preferences, IFEHC's HIPAA Compliance Officer will make it known. Your sole recourse will be to demonstrate that your indicated preference(s) do not conflict with applicable statute(s) and would not present an undue burden to any business. Published 08/06/2024.

IFEHC values transparency. You will notice the website reads like a handbook. Our registration documents, foundational documents, and all policies can be readily accessed online. IFEHC fully accounts for the money it spends. Should you have questions, call IFEHC's office number. You will speak directly to the Medical Director and receive an immediate answer. Once formed, IFEHC's Board of Directors will make known to the public and any other requesting parties its meetings.

IFEHC efficiently utilizes resources by not investing in unnecessary overhead. The Medical Director directly oversees all operations: answers the phone, triages, schedules appointments, sees patients, does basic clerical work such as mailing letters. The result? IFEHC's marginal cost for a routine doctor's visit is only about 55¢. Each year's annual budget is only expected to be about $45,000, a value equivalent to the median wage of one adult in the U.S. We doubt there are any other doctors' offices in the U.S. that operate on that low of an annual budget. In addition, we recycle and do everything possible to conserve resources.

IFEHC tailors its services to the lower middle wage earners in the Noncoastal West. It provides both ambulatory general medical care for working individuals and employment health (or forensic) evaluations. 

IFEHC provides access to: acute care, management of chronic care, preventive services that are age and gender-specific, occupational health services, and behavioral health needs. IFEHC facilitates, via community resources, access to: oral health care, urgent and emergent care, rehabilitative services & equipment, substance abuse treatment, and optical/eye health.

IFEHC does NOT provide emergency treatment, perform surgery, delivery babies, perform abortions, or prescribe birth control (viz, for non-therapeutic indications).

IFEHC is intended to operate on a franchise model where there is only ONE provider per location and each location is independently managed. Currently, there is only ONE location and thus, only ONE provider.  This model of one provider per location is in place in order to facilitate patient-centered care, because there are fewer handoffs. IFEHC believes in patient-centered care, where patient preferences are sought. It is an ethical imperative for a provider to do his/her best to honor patient preferences. It also leads to better outcomes when patients believe in their treatments. Providers should document having discussed treatment plans with patients/examinees.

Management of referrals. IFEHC has a strong anti-kickback policy, and it also strongly values patient/examinee privacy. The way IFEHC does referrals is the provider does research and recommends other providers. This necessarily entails that patients must be accountable to make the call and ask for the referral provider to request medical records. For numerous reasons (including having a limited scope of services), IFEHC may suggest a patient/examinee receive a second opinion or go to a facility with more technical capabilities. IFEHC has numerous such providers it will suggest. The patient is responsible for following that advice and directing questions accordingly.

IFEHC practices patient-centered care where patients are key players in their healthcare. This involves many responsibilities. First of all, the following two assumptions are repeatedly stated. Any patient/examinee receiving services implicitly consents to applicable policies. Any patient/examinee seeking continued service implicitly consents to updates to applicable policies. Patients must provide health history; especially including allergies, contraindications to treatments, and life-threatening conditions. IFEHC understands the patients it serves often have complicated histories. In instances where patients do not feel they can provide complete information, they should cooperate with requests for medical records. For certain conditions where laws heavily regulate the prescriptions of treatments (e.g., controlled substances), patients/examinees must provide proper documentation. Once patients agree on a treatment plan, they are expected to comply with it. Patients implicitly agree to be accessible. It is a reasonable expectation that patients communicate well. If they are not able to be accessible or to cooperate with treatment plans, they should make known barriers to IFEHC. Good communication includes being forthcoming about why they are going to IFEHC. Patients must be accountable, especially for following up and for arranging transition of care. At a minimum, patients/examinees should respond via their preferred medium of communication. They should also be proactive about drawing to IFEHC's attention any issues. Because iFEHC prides itself in its accessibility, there is no excuse for failure to communicate. In circumstances of transition of care, they must initiate contact and give involved parties (i.e., IFEHC and new providers) permission to communicate.  In the case of forensic encounters, examinees must never obstruct evaluation and communication of final results. It is made clear at the start of each initial encounter that patients or examinees are responsible for staying up-to-date with the clinic's policies. Patients and examinees are given fair warning there is only one permanent personnel at each location. They agree that they must never, through their violation of terms of service, present an undue burden to the clinic that adversely affects the care of other patients/examinees. Patients and examinees are always expected to follow applicable laws and otherwise to abide by widely held social norms.

To the extent other clinicians are available within IFEHC, patients have the right to choose any clinician they want at IFEHC. This right is repeated in the Telemedicine Consent form.

Patients are advised they have the right to seek second opinions. This advice is given to examinees. However, IFEHC qualifies that this advice is subject to stipulations of applicable laws that may limit this right.

Patients and examinees are advised of the existence of medical experts. Per IFEHC's anti-kickback policies, IFEHC encourages patients and examinees to initiate contact with the specialists. Note that given the legal implications of a forensic evaluation, IFEHC reserves the right to restrict the list of specialists from whom an examinee may receive an evaluation. That specialist should be appropriately qualified.

The credentials and educational background of the Medical Director and any other permanent primary care provider are provided on the website (https://ifehc.com/meet-our-director). Key certifications of the Medical Director are found one site. This means they are either posted as certificates or available immediately upon request. Those include the medical license of all states in which the providers are licensed and their specialty board certification(s).

IFEHC practices patient-centered care in which the patient gives input into his/her care. IFEHC makes all possible efforts to respect the patient's right to make decisions about the management of his or her care. IFEHC does this in the Release from Liability statement, which asks patients to declare their preferences on code status. If individuals are not ready to decide, IFEHC counsels them. This right does not fully apply to forensic evaluations, where laws and applicable policies of those requesting the query dictate the terms. In circumstances where IFEHC must act against the wishes of examinees, IFEHC's providers will do their best to communicate proactively. Such communication must NEVER be interpreted as seeking an examinee's consent. To the extent possible within IFEHC's resources, IFEHC goes out of its way to educate patients on their rights. One of IFEHC's core principles is transparency.  The interdisciplinary team involves the patient/examinee in the development of his or her treatment plan. They also work in partnership with the patient/examinee to achieve planned outcomes. As a key step in making sure the patient is always involved, IFEHC demands patient accountability. The patient generally selects his/her specialists and formally asks both parties (i.e., IFEHC and specialists) to communicate.

Moreover, feedback is always sought from patients/examinees on their general preference of clinic operations (e.g., paper records versus electronic records) and the types of services they would like the clinic to offer. When the clinic receives enough input and determines it has the means, it does its best to meet with these stated needs.

Idaho Falls Employment Health Clinic, PLLC, or IFEHC; respects the patient's/examinee's rights. Patients/examinees are counseled numerous times of their rights. These include IFEHC's Description of Clinical Operations, Terms of Service, Release from Liability, Notice of Privacy Practices, Acknowledgement of Notice of Privacy Practices (which separately asks patient/examinee preferences), website, documents available on premises, and Expedited Agreement (which advises of existence of previously mentioned documents). Among those rights (viz, this list is non-exhaustive) are the following.  Patients have the right to seek a second opinion from a clinician of the patient's choosing. Examinees have a similar right, but IFEHC and any involved third party must consent to that provider. Patients and examinees have the right to seek specialty care. When IFEHC offers more sites, patients and examinees can choose a provider of their choice within IFEHC. Again, there is one provider per site. Thus, this third right (i.e., choosing provider within primary care medical home) is currently inapplicable.

In the patient/examinee intake as well as subsequent encounters, IFEHC addresses the patient's communication needs. IFEHC immediately determines as part of the contact information form a patient/examinee's emergency contact and any confidentiality concerns. As part of ascertaining contact information and obtaining consent to Notice of Privacy Practices, IFEHC determines whether patient/examinee would like IFEHC's providers to communicate through another individual such as emergency contact. A second need assessed is language. IFEHC always determines prior to the encounter if a language other than English is spoken. If the language is other than English, IFEHC enters into discussion about the available interpretation resources, advises the benefits and drawbacks/risks of each means available, determines whether they are acceptable to the patient/examinee, and determines patient/examinee preference. Advising of benefits and risks includes advising patients/examinees about involvement of family members as interpreters. Importantly, it involves advising of privacy and/or security concerns with certain modes such as online translation software and other artificial intelligence. A third communication need determined is preferred learning style and/or presence of learning disabilities. As part of the Release from Liability, IFEHC asks individuals to initial statements indicating that the document is legible and any declaration of learning preferences/disabilities (or lack thereof).  The designated record set (DRS) must document the above. The above are documented as part of the contact form (of note, not a signed document), the Release from Liability questions, Notice of Privacy Practices Acknowledgment, and encounter note. The encounter note is generally drafted from a template which always encourages clinician(s) to seek the above information. An appropriate section in the encounter note to document is in the Attestation. It should document the name of the patient/examinee, the language of the encounter, the means of interpretation, who was present (viz, if anyone other than patient/examinee), that the findings were discussed with the patient/examinee, that the patient/examinee was given the opportunity to ask questions, and that the patient/examinee agrees with treatment plan.  As part of being an accessible clinic, IFEHC has limited means. It currently does not have the resources to provide trained and accredited interpreters. Patients/examinees are made aware of this shortcoming and must consent to it.

See IFEHC's Privacy Practices and Notice of Privacy Practices for details about the types of information IFEHC collects about its examinees. Below we comment on IFEHC's position on work history, family history, and race and ethnicity.  Work History. Idaho Falls Employment Health Clinic, PLLC, or IFEHC; is an employment health clinic. IFEHC's Medical Director is board certified by the American Board of Preventive Medicine (ABPM) in Occupational & Environmental Medicine (OEM). He believes strongly that work history, including occupational risk factors and exposures, is essential to both medical and forensic encounters.  Family History. This is collected for any patients receiving primary care. It is selectively collected for forensic cases. With forensic cases, IFEHC treats family history as sensitive information as it can potentially be used in violation of the Genetic Information Nondiscrimation Act (GINA). When it is collected with forensic cases, IFEHC will not release the information even with a signed release. Examinees must separately consent to release of information of sensitive information.  Race and ethnicity. IFEHC regards race and ethnicity as part of one's genetic information. For medical care purposes, IFEHC only collects information on race and ethnicity when the clinician believes it will assist with diagnosis and management of disease. With forensic cases, IFEHC generally does not collect information regarding race and ethnicity. This is to protect the examinee from genetic discrimination and racial/ethnic discrimination should DRS be subject to subpoena.

Idaho Falls Employment Health Clinic, PLLC, or IFEHC goes out of its way to identify the patient's health literacy needs. The Medical Director, who has substantial training in biomedical ethics, recognizes patients/examinees do not truly consent if they do not understand the documents to which they consent. The Medical Director agrees with the Joint Commission that "[h]ealth literacy is typically an interactive process, the goal of which is to ascertain the patient's capacity to obtain, process, and understand basic health information needed to make appropriate health decisions." The Medical Director does his best to minimize miscommunications by spending (on average) 10 minutes discussing the documents IFEHC requires its patients/examinees to sign. The Medical Director gauges each person's understanding. This task of signing documents is never delegated. See the discussion on communication needs for details on how patient/examinee needs are determined.

Education should be consistent with patient's health literacy needs. As part of patient-centered care, IFEHC's providers first determine the preferences of the patient/examinee. The provider verbally counsels the plan. For complicated treatments (including those with many components), the provider will give the examinee an after visit summary. This will either be a handwritten note to be photocopied into the chart or an encrypted electronic communication. When the patient/examinee consents, this can include communication with a designated individual. Although IFEHC holds patients accountable for their care, the provider will provide extra follow-up and counseling if it is made known to the provider that the patient/examinee has a barrier.

As part of IFEHC's commitment to patient-centered care, patients determine with their provider self-management goals. These are determined by the patient in partnership with involved parties (such as the primary care provider and anyone else on the healthcare team), criteria established by IFEHC, and it is made part of the treatment plan. For disease management, IFEHC has treatment guidelines that it has developed as part of its quality improvement efforts. For prevention, IFEHC generally uses the guidelines of the U.S. Preventive Services Task Force (U.S.P.S.T.F.) and the American College of Obstetrics & Gynecology (ACOG). Providers are encouraged to consult these guidelines. They must determine the applicability of the guidelines based on patient characteristics. These characteristics can include work schedule, type of physical demands work places on them, income status (e.g., whether treatments are affordable), patient learning level (viz, to determine appropriate complexity of treatment), and patient values/preferences. The patient/examinee must understand the plan. If the patient/examinee does not agree with it, it should be diagnosed the patient/examinee went against medical advice. In the instance of forensic evaluation, notification of third parties may be appropriate where stipulated in law, applicable policies, and applicable agreements.

IFEHC's providers and the multidisciplinary team must educate patients and examinees (when applicable) on self-management tools and techniques based on the patient's individual needs. Those needs include learning needs, language needs, socioeconomic barriers, occupational needs, and patient preferences. In advising patients/examinees of third parties, IFEHC does its best to take into account patient needs (typically financial). In the likely event that the pricing would be unacceptable to the patient, IFEHC does its best to obtain information about the third party and report it to the patient. Thus, third parties are more likely at IFEHC to be sensitive to patients' needs. Unless otherwise stated, the party prescribing a treatment is responsible for making sure the treatment is appropriate and that the patient/examinee appropriately understands it.

The organization provides care that addresses various phases of a patient’s lifespan. This includes both treatment and wellness checks in accordance with aforementioned  (U.S.P.S.T.F. and A.C.O.G.) clinical guidelines. In a limited capacity, this includes end of life care. IFEHC initiates discussion with all of its patients about code status. However, IFEHC does not have an inpatient or palliative care facility.

One of the organizational goals of IFEHC is non-politically partisan public advocacy, and the creed of IFEHC involves responding to the needs of the community. Thus; IFEHC routinely assesses, monitors, and manages the health care needs and outcomes of the community as well as individuals. The goals are to improve the health of the population, increase awareness of behavior of behavior-related health risks, promote healthy lifestyles and patient self-management, and decrease health care inequities. IFEHC is applying for membership of the Idaho Association of Free & Charitable Clinics (IAFCC). We partner with other clinics on different initiatives. Our clinic promotes materials from other clinics as well as from government agencies such as the Department of Public Health and Idaho's state-run healthcare exchange. IFEHC's Medical Director has various speaking engagements, including with local media. IFEHC makes applicable public service announcements, such as informing the public of deadlines to enroll in insurance and qualify for the Advanced Premium Tax Credit (APTC). As an employment health clinic, IFEHC has a strong relationship with its local (Idaho Falls) Department of Labor. The medical director has addressed the local department and has been in regular discussion about employee health needs. IFEHC is determining how to measure the successes of its population health initiatives.

The members of the interdisciplinary team, except for the primary care provider at IFEHC, generally consist of external referrals. The members of the team provide comprehensive and coordinated care. They maintain continuity of care. The responsibility of coordinating care rests with the primary care physician once the primary care physician is notified of the involvement of the specialist. Again; per IFEHC's anti kickback policy and emphasis on patient-centered care, the preference is usually for patients/examinees to initiate encounters with other multidisciplinary team members.  Note that the primary care physician is not always the provider at IFEHC. In certain cases where patients learn they are eligible for public aid or other applicable private insurance that requires a new primary care provider, the new primary provider is responsible for coordination. Note that IFEHC is not part of Medicaid or Medicare. These assumptions hold unless otherwise communicated.

The interdisciplinary team members participate in the development of the patient's/examinee's treatment plan, which includes setting goals. They work with the patient. IFEHC believes patient/examinee input is more likely to be sought since patient/examinees choose their team. Because each patient chooses his/her interdisciplinary team, it is not possible to assure a panel of patients for each interdisciplinary team. As part of forming a plan with which the patient/examinee can be compliant, the team assess patients/examinees for health risk behaviors. These should be documented as part of social history and assessment in at least one patient/examinee encounter note. The interdisciplinary team monitors patient's/examinee's progress towards achieving goals. It seeks patient/examinee input on how patient/examinee feels s/he is progressing. 

IFEHC provides patients with 24/7 access, 7 days a week to the following:

• Contact IFEHC's primary care medical home to obtain same day or next day appointment. Note that this includes telemedicine.
• Request prescription renewal.
• Obtain clinical advice for urgent health needs.

All of the above are via telephone. Calls do not go to a call center. They directly reach the Medical Director, who answers 24/7.

IFEHC has a process to respond to patient urgent care needs 24 hours a day, 7 days a week. First, the public (here referring to non-established patients) is educated (via advertisement and the website) that the clinic is by appointment only and not appropriate for emergencies. IFEHC makes this point by making it difficult to access IFEHC's address online without calling first. Everyone is informed to call 911 if experiencing a medical emergency. Should someone in the public show up unannounced with an urgent medical need when no one is present or available, there is a list of nearby urgent care and emergency department facilities. Second, patients understand they can reach the Medical Director 24/7. They are encouraged to reach the Medical Director if experiencing any concerning signs/symptoms. They are also instructed multiple times to call 911 if experiencing a medical emergency. They are told this via intake encounter instructions, the terms of service, instructions given in after visit summaries, the website, and the clinic's outgoing voicemail message. In circumstances when the Medical Director is not available or the needs of the patient/person inquiring are outside the clinic's capabilities, the Medical Director advises patients either to go to urgent care or the emergency room. Because the Medical Director answers the phone, the Medical Director is in a position to triage and direct accordingly.

IFEHC provides its patients and examinees timely access to their designated record set (DRS).  Patients and examinees can access diagnostic and therapeutic information made available to IFEHC as soon as IFEHC receives it. Such information would include diagnostic test results, lab results, summary lists, and medication lists. During the intake session, IFEHC asks patients/examinees to indicate their privacy preferences as part of the Contact Form and Notice of Privacy Practices Acknowledgment. Timeliness of information provided depends on patient/examinee preferences last (patients/examinees are advised of the right to change their preferences) indicated. Assuming there are no restrictions placed, patients/examinees can generally access any information from their DRS within four (4) days of making a request. There is no online portal, as IFEHC does not use electronic health records (EHR). Options include telephone, text message, encrypted electronic communications, or certified U.S. Postal Mail. Since interdisciplinary team members will necessarily be from other facilities, IFEHC cannot guarantee timeliness. IFEHC will happily query multidisciplinary team members when it receives queries from patients. However, IFEHC assigns any member of the interdisciplinary team responsibility of conveying results to IFEHC as soon as they are received.  All patients and examinees are advised that since the Medical Director exclusively runs IFEHC, there could be circumstances when such information is not immediately available. This will generally apply to information the Medical Director does not deem urgent. Such circumstances could arise if the Medical Director needs to leave town. Although IFEHC will do its best to provide information within the DRS within four (4) days; it advises all patients and examinees that the Office of Civil Rights (OCR), who enforces HIPAA, technically allows up to 60 days per request for a covered entity to comply. The 60 days consist of 30 days plus a one-time 30-day extension per request. Should an unusual circumstance arise where IFEHC's Medical Director cannot be reached, IFEHC has designated an alternate contact for DRS requests. This information can be found on IFEHC's website under the contact's section or on Utah's Division of Professional Licensing (DOPL) license lookup for Medical Director D.M. Boren, M.D.

IFEHC's Medical Director makes all possible efforts to see patients and examinees as soon as possible. They are typically seen within one or two days of making an initial call. Thus, reminders are not typically necessary. The Medical Director uses his discretion when to send reminders. Those are typically for cases that are more than two days away from the initial call. They are done using a medium of the patient or examinee's choice. Note that if e-mail is used, the Medical Director leaves out protected health information (PHI) such as the patient's name. The only PHI is necessarily the e-mail address. Details are minimized. IFEHC does NOT use electronic health records (EHR) and thus cannot send out automatic reminders using EHR. 

IFEHC proudly uses paper records. The decision is informed by a number of considerations. First, IFEHC has a creed of the community solving its own problems and placing high value on the feedback and input patients and members of the community have given us. While we have not done a scientific poll, we have determined that the majority of people in the community do not trust electronic health records (EHR).  We are confident many of our established patients/examinees would feel betrayed if we converted to computer records. Second, one of IFEHC's core values is patient privacy. It is the Medical Director's opinion that IFEHC's records are safer because they are not vulnerable to cyber attacks. Hospitals, banks, and even our infrastructure have been hacked. Third, IFEHC does not process payments. Thus, IFEHC is not subject to stipulations of Centers for Medicare & Medicaid Services (CMS) that EHR be used.

As indicated, IFEHC uses paper records. However, IFEHC performs successfully the functions an EHR is intended to perform. First; IFEHC's record system supports the continuity of care and provision of comprehensive coordinated care simply by being very accessible. The Medical Director can be reached 24/7. The Medical Director has the ability to submit electronically encrypted files, to fax files, to mail files certified, or (in most cases) to deliver files. IFEHC documents and tracks care, treatment, or services in the files. In certain instances, IFEHC allows electronic communications to count as documentation. Patients/examinees are advised of the risks/benefits of such means of communication. Applicable communications are added to the DRS. IFEHC's providers support disease management by providing patient education. IFEHC's Medical Director has training by NIOSH in evidence-based medicine and is also familiar with the guidelines. As part of its quality improvement, IFEHC continues to add to its Treatment Guidelines patient education templates. Given IFEHC's focus on tailoring care to the language and educational needs of patients/examinees, IFEHC finds it best to tailor each educational sheet to its patients/examinees. Regarding continuity and coordination of care, IFEHC believes there is no substitute for communication. Even if EHR were used, not all EHR can communicate. IFEHC is able to create reports for internal use. Despite not using EHR, IFEHC assigns a medical record number (MRN) to each case. That helps keep track of cases as well as create a denominator. Since only one provider sees all patients, the provider knows a lot of qualitative information and can glean the big picture. Another function of EHR is to create and submit reports to external providers/orgs, public health agencies, disease-specific, immunization, other specialized registries. IFEHC has such low volume of applicable cases that it can report as it encounters cases. Electronic exchange of information among providers is done using HIPAA-compliant means. This includes electronic communications that leave out PHI, including all identifiable information. As mentioned, IFEHC places a premium on direct verbal communication with other providers. IFEHC regularly does quality control. The Notice of Privacy Practices advises patients/examinees of quality control. There are practices in place for including quality improvement in patient files without making them part of the DRS. Finally, IFEHC repeats that it is the provider's responsibility to identify and provide patient-specific education resources. IFEHC prides itself in having a level of expertise that it can create its own resources or quickly locate and grade applicable resources available elsewhere. It can send such resources to patients/examinees using the medium of their choice.

IFEHC does not currently use e-Prescribing. e-Prescibing is prohibitively expensive. If IFEHC becomes aware of free or low-cost software available, it may reconsider this position. In matters where there are questions about safety (e.g., a second-line drug or maximum dose), IFEHC will ask to call in the drug directly. IFEHC frequently uses fax or its provider personally delivers a prescription. IFEHC's Medical Director will reassess this situation as he reassesses the requirements of other states where he is licensed.

As IFEHC does not use EHR, it does not use EHR-based clinical decision making tools. Other than referral to specialists, there is minimal handoff. IFEHC's Medical Director gathers the entire patient/examinee history and (except where specialists are involved) initiates and maintains treatments. IFEHC's Medical Director practices evidence-based medicine where queries are sent to databases such as PubMed, balanced literature results are yielded, and articles are graded. In addition, IFEHC's Medical Director consults a growing network of specialists and practitioners in other fields such as pharmacy for input. A final control is that IFEHC has a low number of volume rate of new patients, making it possible to give careful consideration to each case. 

IFEHC places a premium on quality improvement. IFEHC collects the following internal data.

(1) Disease management outcomes. IFEHC's Medical Director directly tracks the information in the charts and in a log book. If the Medical Director does not hear from a patient, he will make multiple attempts to reach. This is a fundamental aspect of upholding the duty of a therapeutic relationship.

(2) Patient access to care. The following statistic only applies to individuals who become patients at IFEHC.  IFEHC strives to have an appointment scheduled within a week of the initial contact. If the Medical Director determines within 3 days of the initial contact that an individual should go to a different provider, this encounter does not count towards the statistic. 

IFEHC makes efforts to survey its patients on their experiences. During discussions with patients (e.g., gathering information on the outcomes), IFEHC will make efforts to conduct the following survey by interview. In addition to receiving direct responses to the following four metrics, IFEHC will seek qualitative feedback. If IFEHC has that data but otherwise does not have a reason to contact the patient, IFEHC will consider sending the patient a written survey that asks the following. In the written survey, patients will be asked if they want to participate in focus groups or would like to be called to be interviewed.

(1) Patient experience and satisfaction related to access to care and communication.

(2) Patient perception of comprehensiveness of care.

(3) Patient perception of the coordination of care.

(4) Patient perception of the continuity of care.

IFEHC actively participates in performance improvement activities. That includes looking up scholarly articles, using cases to update treatment protocols, and even rewriting notes. The interdisciplinary team members are generally not part of IFEHC and are thus not bound to these requirements. However, IFEHC will discuss the outcomes of cases and other team members' perceptions. These discussions will be informally held. They can be one-on-one with medical director rather than being a round table format. It is made clear to patients in the Notice of Privacy Practices that quality improvement is a regular activity at IFEHC and is not considered part of Designated Record Set (DRS) that can be produced with records releases.

According to the Joint Commission: "The organization evaluates how effectively the primary care clinician and the interdisciplinary team work in partnership with the patient to support the continuity of care and the provision of comprehensive and coordinated care, treatment, or services." IFEHC is currently run by only one individual. Interdisciplinary teams do not have panels of patients. It is thus difficult to have standardized or structured discussions. However, the Medical Director will assume responsibility for ascertaining and recording feedback provided by various interdisciplinary team members. The Medical Director will also record his own perceptions.